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WALGREENS SPECIALTY PHARMACY, LLC
DSH390073 ALTOONA REGIONAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
ALTOONA REGIONAL HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390073
Entity Address
620 HOWARD AVENUE
ALTOONA, PA 16601-4889
Medicare Provider Number
390073
Participating Start Date
10/1/2018
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Monica J Klatt, Chief Financial Officer
(814) 889-2223
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2022
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